Qin et al. BMC Endocrine Disorders (2016) 16:27 DOI 10.1186/s12902-016-0106-x
RESEARCH ARTICLE
Open Access
Metabolic syndrome and osteoporotic fracture: a population-based study in China Li Qin1,2, Zhen Yang1,2*, Weiwei Zhang2, Hongxia Gu1, Xiaoyong Li2, Lingfei Zhu2, Shuai Lu1, Yin Xing1, Hongmei Zhang2, Yixin Niu2, Guang Ning3 and Qing Su1,2*
Abstract Background: Associations between metabolic syndrome (MetS) and osteoporotic fracture have been reported. However, the epidemiological studies are not conclusive. The objective of the study was to determine whether metabolic syndrome associates with osteoporotic fracture. Methods: This was a cross-sectional study of 9930 Chinese adults aged 40 year or older in the Chongming District, Shanghai, China. A questionnaire, anthropometric measurements and laboratory tests were conducted. MetS was defined according to the updated National Cholesterol Education Program Adult Treatment Panel III criteria for Asian-Americans. A history of fractures was collected with an interviewer-assisted questionnaire. Osteoporotic fractures were defined as fractures that occurred due to low-trauma in 2 years prior to the study. Results: Among women, the prevalence of osteoporotic fractures was significantly higher in those with MetS (3.5 vs. 2.6 %, P =0.028). However, the difference was not found in men (2.6 vs. 2.4 %, P =0.737). The presence of Mets was significantly associated with increased odds of osteoporotic fracture among women (odds ratio 1.22; 95 % confidence interval 1.12–1.54; P = 0.039) after controlling for potential confounders. The significant associations were not detected in men. Conclusions: The presence of MetS was significantly associated with a recent history of osteoporotic fracture in middle-aged and elderly Chinese women. Keywords: Metabolic syndrome, Osteoporotic fractures, Central obesity
What’s new? ✓ In this study we found the presence of MetS was significantly associated with a recent history of osteoporotic fracture in a large sample of middleaged and elderly Chinese women. ✓ We found central obesity seem to have the strongest associations with prevalence of osteoporotic facture in women. ✓ Our study indicated bone metabolism seems to be more markedly affected in women than in men with metabolic syndrome.
* Correspondence:
[email protected];
[email protected] 1 Department of Endocrinology, Xinhua hospital Chongming branch, School of medicine, Shanghai Jiaotong University, 25 Nanmen Road, Shanghai, China Full list of author information is available at the end of the article
Background With the rapid economic growth and the ageing of its population in China, osteoporosis has become one of the most prevalent and debilitating chronic diseases. It has often been called “the silent epidemic” because bone loss is a slow asymptomatic process. Only when fractures occur does the disease become symptomatic. Recently, osteoporotic fracture has become an increasingly important problem in elderly populations and place a progressively heavy burden on health services [1, 2]. Nutritional, lifestyle, hormonal, metabolic, and genetic factors contribute to the occurrence of osteoporotic fracture [2]. Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors has been defined as central obesity, hypertension, impaired glucose tolerance, and dyslipidemia (specifically hypertriglyceridemia, along with low levels of high-density lipoprotein cholesterol [HDL-c]).
© 2016 Qin et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Qin et al. BMC Endocrine Disorders (2016) 16:27
It is a public health problem because about 30–50 % of the middle-aged and elderly people has MetS in China [3, 4]. MetS is associated with a higher risk of cardiovascular morbidity and mortality and a higher risk of onset of type 2 diabetes. Although the relationship between cardiovascular disease and osteoporosis has been widely studied, the particular association between metabolic syndrome, a strong risk factor for cardiovascular disease, and osteoporotic fractures has not been so extensively addressed and present several studies results were inconsistent [5–15]. Epidemiological studies on fracture incidence or prevalence are therefore needed in order to show the real pattern of fractures in MetS. In addition, because metabolic syndrome consists of several single components that could have their own independent relationship with osteoporosis, the possible association of each of them with the osteoporotic fracture is also worth considering. Thus, the present study intended to evaluate the association between MetS and osteoporotic fracture in a population-based survey of middle-aged and elderly Chinese people in Shanghai, China. We also examined the association of each of the individual components of metabolic syndrome with osteoporotic fracture.
Methods Study population and design
In 2011 China a national survey of Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study, which was conducted among 259,657 adults, aged 40 years and older in 25 communities across mainland China, from 2011 to 2012 [16]. The data presented in this article are based on the baseline survey of subsamples from Shanghai in eastern China. All studied individuals came from the Chongming District in Shanghai, China [17–19]. Written consent was obtained from all the participants. The protocol was approved by the Ethics Committee of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine. Data collection
A standardized questionnaire was used by trained physicians to collect information such as age, sex, medications [17–19]. The methods of biochemical measurements refer as previous studies [17–19]. Physical activity at leisure time was estimated using the short form of the International Physical Activity Questionnaire by adding questions on frequency and duration of moderate and vigorous activities and walking [20]. For evaluation of total physical activity, separate metabolic equivalent hours per week (MET-h/wk) were calculated. Anthropometric measurements were performed by the trained personnel using a standardized protocol [17–19].
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BMI was calculated as body weight in kilograms divided by height squared in meters. The abbreviated Modification of Diet in Renal Disease formula recalibrated for Chinese [21]. Definition of MetS
The MetS was defined based upon the updated NCEP-ATPIII for Asian Americans as presenting 3 or more of the following components: 1) waist cirumference ≥90 cm for men or ≥80 cm for women; 2) triglycerides ≥1.7 mmol/l; 3) HDL cholesterol
